In much of the United States, "little is known about HIV care among rural populations," the authors wrote. Women living with HIV in rural areas often have considerably less access to care than their counterparts in urban and suburban settings. The current study explores barriers to care for HIV-positive women in rural California. Research methods included retrospective structured interviews with 64 women in rural areas receiving HIV care at 11 health care facilities, which were randomly sampled. All HIV-positive females in care at these facilities during a specified time range were eligible.

The following proportions of respondents cited these barriers to care:

32.8 percent cited physical health problems that prevented travel to access care. Compared to being married or single, being divorced, separated or widowed was associated with reporting physical health as a barrier (p=0.03).

31.2 percent cited lack of transportation. Being unemployed (p=0.003) or having to travel 31-90 minutes (p=0.007, compared to less than 31 or more than 90 minutes) were both associated with citing transportation as a barrier.

25.0 percent cited inability to navigate the health care system. Speaking English rather than Spanish was associated with difficulty navigating the health care system (p=0.04).

Twenty-four (37.5 percent) of the women missed an HIV-related medical appointment in the preceding 12 months, chiefly due to physical health and transportation problems. Difficulty traveling to appointments was reported by 29 (45.3 percent) of the women.

"Physical health and transportation problems were both the major barriers to accessing health services and the primary reasons for missing HIV care appointments among this population of HIV-infected women living in rural areas," the authors concluded. "Providing transportation programs and/or mobile clinics, as well as providing support for patients with physical limitations, may be essential to improving access to HIV care in rural areas."

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